The BNF states that barrier creams are not a substitute for adequate nursing care, or regular nappy changing (babies), and it is doubtful that they are any more effective than the traditional compound zinc ointments.

NHS England (NHSE) has published new prescribing guidance for various common conditions for which over the counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). One of these conditions is nappy rash.

Many of these products are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.

NB: Cavilon cream and Proshield are included as part of the Wound Management Formulary but should not be used for routine barrier cream application.

Conotrane

(Benzalkonium chloride and dimeticone)

• Cream (£4.98 = 500g)

Indications

• Nappy rash
• Urinary rash (not suitable for use on patients with continence pads)
• Pressure sores

Notes

1. Tube has longer in-use shelf life than pots; only a small amount is required for each application.
2. Water repellent, protects skin from moisture, irritants, chafing and contamination with yeasts or bacteria.

Drapolene

(Benzalkonium chloride and cetrimide)

• Cream (£8.43 = 350g) (£12.04 = 500g)

Indications

• For nappy and urinary rash; minor wounds

Zinc and castor oil

• Ointment (£5.15 = 500g)

Indications

• For nappy and urinary rash

Sudocrem Antiseptic Healing Cream

(Benzyl alcohol with benzyl benzoate, benzyl cinnamate, lanolin and zinc oxide)

• Cream (£10.99 = 400g) (£13.74 = 500g)

Indications

• Nappy rash
• Pressure sores

Notes

1. Sudocrem is water repellent; protects skin from moisture, irritants and chafing.
2. Reduces inflammation, weak local anaesthetic action.

Metanium

(Titanium dioxide with titanium peroxide and titanium salicylate)

• Nappy rash ointment (£3.34 = 30g) (£55.67 = 500g)

The following products should not be used for routine barrier cream application

A soap substitute (e.g. proprietory shower gel)

• for normal skin care cleansing/hygiene when the skin is vulnerable for example with incontinence. (Soap and water is not recommended for cleansing a patient with urinary or faecal incontinence as it is alkaline and can upset the pH balance of the skin) (Beldon 2007)
• Products should only be prescribed if there is a therapeutic need. There should be a clear rationale for the prescriber item documented in the notes/careplan, and there should be regular review of the indication for the prescribed item

A liquid barrier cream, Medi Derma-S

• To prevent skin damage from moisture exposure and for moisturising patients' skin who are at high risk of developing a moisture lesion or incontinence-associated dermatitis, as identified by a skin assessment (such as those with incontinence, oedema, dry or inflamed skin). This can be applied to dry, intact skin and damaged skin. They provide a barrier between the skin and the irritant. Sachets should only be used in the Secondary Care setting. In the Primary Care setting, in patient's homes and in care homes, tubes should be used.

A liquid barrier film, Medi Derma-S

• To prevent skin damage from moisture exposure, and can be applied to damaged/ excoriated and/or intact skin, without stinging and dry quickly to provide a waterproof barrier protective against irritants such as faeces and urine. They contain silicone polymers such as dimethicone and create a dry, water repellent, transparent barrier. The film locks in moisture to hydrate and protect the skin. For use in small areas such as around stomas and wounds. The aerosol is used for greater surface areas and difficult to reach areas.

Proshield Cleanser spray/foam

• For cleansing (no rinsing required), the damaged/severely excoriated skin, and is normally for short term use. It is not for routine cleansing of intact skin

Please note that applying multiple layers of barrier products should be avoided. It will make the area uncomfortable for the patient and cracking of the product can occur which will allow moisture to penetrate.

Skin barriers are used where the skin is being damaged by fluid from a wound, fistula or stoma or the epidermis is being stripped by frequent changing of adhesive products.

Medi Derma-S

• Barrier cream 2g sachet (£5.85 = 20 sachets)
• Barrier cream 90g (£5.95)
• Non-sting barrier applicator 1ml, 3ml (£3.70, £5.95 = 5)
• Non-sting barrier film 50ml spray (£8.95)
• Barrier film wipes (£19.40 = 30)

Cavilon

• Durable barrier cream 2g sachet (£6.55 = 20 sachets)
• Durable barrier cream 28g, 92g (£3.32, £6.55)
• Non-sting barrier film applicator 1ml, 3ml (£4.09, £6.62 = 5)
• Non-sting barrier film 28ml pump spray (£5.85)

Proshield

• Foam & spray cleanser 225ml (£6.84)

Notes

1. For use in Plymouth Community Healthcare, Plymouth Hospitals NHS Trust under the advice of Tissue Viability

Proshield Plus

• Skin protectant 115g (£10.29)

Notes

1. For use in Plymouth Community Healthcare, Plymouth Hospitals NHS Trust under the advice of Tissue Viability

Opsite spray

• 100ml

Notes

1. Opsite spray is a spray on dressing which provides protection for dry minor surgical and surface wounds. It is not available on FP10 prescription.
2. For use in South Devon Healthcare

Adhesive remover

Appeel

• No sting medical adhesive remover wipes (£16.83 = 30 wipes)
• No sting medical adhesive remover spray 50ml (£10.15)
• Sterile medical adhesive remover 5ml sachet (£1.24)

Notes

1. Appeel is a silicone based medical adhesive remover that contains a moisturiser. The no sting formula dries quickly allowing adhesion of replacement dressings. There is no need to wash off during dressing changes. It should be reserved for use in patients undergoing repeated dressings changes, children or patients having Topical Negative Pressure therapy.
2. Appeel sterile sachet can be used on extremely sensitive or broken skin or where there is a very high risk of infection.